SINGLE PAYER AND SOCIAL JUSTICE: CHANGING THE DIALOGUE

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Presentation transcript:

SINGLE PAYER AND SOCIAL JUSTICE: CHANGING THE DIALOGUE Olveen Carrasquillo, MD, MPH Professor of Medicine and Public Health Chief, Division of General Internal Medicine Interim Chief, Geriatrics & Palliative Care

Carrasquillo & Muller, Refinement of the Affordable Care Act: A Progressive Perspective Ann Rev Medicine Jan 2018

Refinement of the Affordable Care Act: A Progressive Perspective 3 Important limitations of ACA ACA did not achieve universal coverage Many states chose not Expand Medicaid Premium Assistance was insufficient to get many to sign up Undocumented were excluded ACA continues to perpetuate inequities in our health system Disparities in coverage persist Medicaid is not equitable coverage Marketplace plans are not not equitable coverage (not comprehensive / limit choice) Used a very expensive approach to expanding coverage Could have been done for much less and covered everyone Carrasquillo & Muller, Refinement of the Affordable Care Act: A Progressive Perspective Ann Rev Medicine Jan 2018

What is wrong with this picture?

Whom is left out? Large Numbers of Immigrant Latinos Remain Uninsured Percent adults ages 19–64 uninsured Source: The Commonwealth Fund Affordable Care Act Tracking Surveys, July–September 2013 and February–April 2016.

Another way Frame ACA and Latinos 4 million Latinos gained coverage under ACA, 9 million did not 70% of uninsured Latinos did not benefit from ACA Hispanics still 150% more likely be uninsured than whites Blacks 60% more likely to be uninsured than NHWs Black or Latino make up 33% of population But they make up 55% of uninsured

Strong bi-partisan agreement that undocumented will get no benefit from ACA FB Latinos Make Up 75% of Uninsured Latinos: Most Are Low-Income and Do Not Speak English Well Income How well do you speak English? Uninsured Latino adults ages 19–64 who are foreign-born Uninsured Latino adults ages 19–64 who are foreign-born and whose interview was conducted in Spanish Note: 78 percent of uninsured Latinos are foreign-born. Source: The Commonwealth Fund Affordable Care Act Tracking Survey, February–April 2016.

What KS told me in 2014… "Of course the Obama administration cares deeply about the health care needs of the undocumented. It is just so sad that politically there is nothing we can do about it. This is why we have no plans of trying to address this anytime soon.” Carrasquillo, O. Nat Inst Latino Policy Blog May 13, 2016 http://www.nilpnetwork.org/NiLP-Archives.html

Medicaid- is not equitable coverage!!!! How much do you want do you paid for 20 minutes of your time? A. $ 10 B. $ 30 C. $ 70 D. $100

Inequitable Coverage!!!

How will single payer help Universal Coverage- Everyone is and nobody out Includes undocumented!! Equitable High Quality (well compensated) Coverage Will that end disparities? Of course not

Other issues

Will Single Payer Help

Social Determinants of Health Conditions in which people are born, grow, live, work and age Shaped by the distribution of money, power and resources at global, national and local levels Mostly responsible for health inequities

SDH Access to social and economic opportunities Resources and supports available in our homes, neighborhoods, and communities Quality of our schooling Safety of our workplaces Cleanliness of our water, food, and air Nature of our social interactions and relationships.

Will Single Payer Fix This? Mona Hanna-Attisha et al . Elevated Blood Lead Levels in Children Associated With the Flint Drinking Water Crisis AJPH Feb 2016

Will Single Payer Fix this?

S. 1804 Medicare for All Act of 2017 term ‘‘United States’’ shall include the States, the District of Columbia, and the territories of the United States SEC. 502. ADDRESSING HEALTH CARE DISPARITIES. Endorsed by Latinos for Healthcare Equality League of United Latin American Citizens (LULAC) H.R.261 — 115th Congress This bill amends title XVIII (Medicare) of the Social Security Act to automatically enroll eligible residents of Puerto Rico in Medicare's medical insurance program.

Will single payer help? Yes!!! But…. Universal Coverage- Everyone is and nobody out Equitable High Quality (well compensated) Coverage But…. Will not address other major drivers disparities Many other issues aside from insurance Cultural competence/ language  SDH We need to be seen as advocates on these other issues as well